Haemorrhagic stroke

Haemorrhagic stroke is when the blood supply to your brain is cut off when a blood vessel bursts and bleeds (haemorrhages) into your brain. This stops your brain getting the oxygen and nutrients it needs, and the blood puts pressure on your brain, which can damage it. The sooner you get treatment for a haemorrhagic stroke, the less damage is likely to happen.

Types of haemorrhagic stroke

There are different types of stroke. This topic is about haemorrhagic stroke, but we also have information about ischaemic stroke.

About 15 people out of every 100 who have a stroke have a haemorrhagic stroke. And there are two main types.

Intracerebral haemorrhage. This is caused by bleeding from a blood vessel inside your brain and is the most common type.

Subarachnoid haemorrhage. This is caused by bleeding from a blood vessel on the surface of your brain into the subarachnoid space. This is an area between your brain and the lining that covers it and contains cerebrospinal fluid that surrounds your brain and spine.

Symptoms of haemorrhagic stroke

The symptoms of a stroke usually come on suddenly, within seconds or minutes.

It’s vital that you can recognise if you, or someone you’re with, is having a stroke so you can get immediate treatment. A good way to remember the signs of one is to use the ‘FAST’ test.

Face. If you’ve had a stroke, your face may feel weak and you won't be able to smile. Your mouth or eye may droop down, usually just on one side.

Arm. You won't be able to raise your arm and hold it there.

Speech. You may have slurred speech or find it difficult to remember the names of common objects.

Time to call 999. If you have one or more of these symptoms, or you see them in anyone else, get emergency help straightaway.

Other symptoms of a haemorrhagic stroke may include:

a sudden, very severe headache

losing consciousness

feeling sick or vomiting

a stiff neck

feeling numb or weak, or unable to move your face, arm or leg on one side of your body

feeling dizzy

vertigo

blurred or double vision – or difficulty seeing at all

feeling confused

seizures (fits)

Diagnosis of haemorrhagic stroke

When you get to hospital, you’ll have some tests to find out what type of stroke you’ve had and how your brain is affected. This will help your doctor to plan your treatment.

an electrocardiogram (ECG) to record the rhythm and electrical activity of your heart

blood tests to measure your pressure, cholesterol and blood sugar levels, and to check how well your blood clots

Lumbar puncture

If your doctor thinks you had a subarachnoid haemorrhage, but your brain scan doesn’t clearly show the bleeding, you may need a lumbar puncture. This test involves taking a sample of the fluid that surrounds your brain and spine from your lower back. This will be tested to see if there’s any blood from your brain in it, which would confirm that you had a haemorrhagic stroke.

Angiogram

If a lumbar puncture does confirm that you’ve had a haemorrhagic stroke, you may need to have an angiogram. In this test, your doctor will inject a dye into your blood vessels to make them show up on X-rays and scans. It will help to find out exactly where the bleeding in your brain is coming from.

Treatment of haemorrhagic stroke

You may be treated in a specialist stroke unit in hospital.

If you can’t swallow, you’ll be given fluid through a drip in your arm to stop you getting dehydrated. And you’ll have a tube in your nose to give you the nutrients and medicines you need. You might also be given oxygen through a face mask to help you breathe.

Nurses will help you to sit up and encourage you to move around as soon as you can. If you can’t move, they’ll help you to turn in your bed regularly. This will reduce your risk of getting bed sores and deep vein thrombosis (DVT). You may also be given a mechanical pump to use on your feet and legs called an intermittent compression device. The pump automatically squeezes your feet and lower legs to help keep your blood moving and prevent a blood clot from forming.

How long you’ll need to stay in hospital will depend on how severe your stroke was and how you’ve been affected by it.

Medicines

The medicines your doctor will give you will depend on the type of haemorrhagic stroke you've had, and if you’re taking any other medicines.

If you’ve had an intracerebral haemorrhage and are taking an anticoagulant, you may need to take medicines that have the opposite effect. An anticoagulant is a medicine that reduces the ability of your blood to clot. Taking a medicine that has the opposite effect will allow your blood to clot and help stop further bleeding in your brain.

You might also need to take:

anticonvulsants, which can help to prevent seizures

antihypertensives to lower your blood pressure if it’s very high, to prevent further bleeding

diuretics to lower the pressure in your brain if it’s very high

If you have a subarachnoid haemorrhage, you may need to take a medicine called nimodipine for a few weeks afterwards. This will help to keep the blood flowing in your brain.

Surgery

If you’ve had a haemorrhagic stroke, you might need to have surgery. Which type of surgery you have will depend on the type of haemorrhagic stroke you’ve had and your own personal circumstances. Your doctor or surgeon will be able to advise which type of surgery is best for you.

The types and reasons for having surgery are outlined below.

Bleeding in your brain from a haemorrhagic stroke can cause pressure to build up and clots to form. You might have surgery to drain the bleed and remove any blood clots – this is known as evacuation. There are lots of different types of surgery to do this. One type involves removing a piece of your skull (known as craniotomy). During this procedure your surgeon can fix the blood vessel, drain the bleed and remove any clots. Other types of surgery involve drilling small holes in your skull and then draining the bleed and any clots using a needle or endoscope (a very small tube-like telescopic camera). Other procedures, involve using CT (computed tomography) to find out where the bleed is, and then a special piece of equipment to suck up the bleed and any clots.

You may also need surgery to reduce the chance of more bleeding (rebleeding). If bleeding is caused by an aneurysm (see our causes section below for more information), you may have a procedure called endovascular coiling. This stops blood pooling into the aneurysm, reducing the chance of it bursting again. In this procedure, your surgeon passes a tube through a small cut in your groin into an artery. They thread this through to reach the aneurysm in your brain and then put small coils in it. This is the most common procedure, but you may have a craniotomy. During the craniotomy, your surgeon puts a clip around the base of the aneurysm to stop it bleeding again.

Some haemorrhagic strokes might cause the amount of cerebral spinal fluid in your brain to increase (hydrocephalus). This raises the pressure in your brain and makes you feel less alert. If this happens, you might need to have the fluid removed. Procedures such as ventricular drainage and lumbar puncture can be used to relieve the pressure. Lumbar puncture is a procedure that might also be used to help diagnose haemorrhagic stroke – see our diagnosis section for more information.

For more information on surgery for haemorrhagic stroke, talk to your doctor or surgeon.

Causes of haemorrhagic stroke

A haemorrhagic stroke is caused by a blood vessel within your skull bursting and bleeding into and around your brain. High blood pressure plays a part in most haemorrhagic strokes – this puts extra strain on your smaller blood vessels so they’re more likely to burst.

You’re also more at risk of having a haemorrhagic stroke as you get older. Although you can have a stroke at any age, most people who have one are over 65. And men are more likely to have one than women. Other things that may increase your risk of having a haemorrhagic stroke include the following.

An aneurysm in your brain, which is a weak spot in your artery wall that widens or bulges outwards and can sometimes burst. An aneurysm can be caused by smoking or high blood pressure, or some people have a family history of them.

Cerebral amyloidosis, which is a condition where a substance called amyloid builds up in the blood vessels in your brain. This can damage your blood vessels so they may burst and bleed.

Abnormalities in the way that blood vessels have formed in your brain. This is called an arteriovenous malformation or a cavernoma. See FAQ: What’s arteriovenous malformation? for more information.

Anything that increases your tendency to bleed. This could be treatment with an anticoagulant medicine that reduces your blood’s ability to clot (for example, warfarin). Or it may happen if you have a health condition that affects how your blood clots, such as haemophilia.

Using illegal drugs, such as cocaine. See FAQ: Cocaine and haemorrhagic strokes below.

Prevention of haemorrhagic stroke

High blood pressure plays a part in most haemorrhagic strokes so you could take steps to reduce this. For tips on how, see our topic on high blood pressure.

You can also prevent a haemorrhagic stroke by not using illegal drugs such as cocaine. If you drink a lot of alcohol or smoke, it’s a good idea to cut down. And try to eat well. See Related information for tips and advice on achieving these.

Frequently asked questions

Haemorrhagic strokes are often more severe than ischaemic strokes and are also more likely to be fatal, but everyone is different. Both haemorrhagic and ischaemic strokes can be fatal for some people, whereas others recover well and manage with the effects of a stroke.

An arteriovenous malformation (AVM) is a tangle of blood vessels that forms when your blood vessels don't connect together properly in your brain. Most people aren’t aware they have an AVM as they don’t usually cause any problems. But you might get symptoms such as headaches and seizures (fits).

Your arteries are connected to your veins by a network of very fine blood vessels called capillaries. In an AVM, the capillaries are missing and your arteries and veins join together in a complex tangle of weakened blood vessels. Over time, the pressure of the blood in the tangle can eventually lead to a blood vessel bursting, which is called a haemorrhage.

If your doctor finds out that you have an AVM, they’ll probably want to monitor it. If it’s likely to burst and bleed, they may suggest you have an operation to remove it. Other treatments involve blocking the blood vessels that make up the AVM with a glue-like material (embolisation), or destroying it with focused radiation beams. This is called gamma knife radiosurgery.

Cocaine causes your blood vessels to suddenly narrow, which can slow down or stop the flow of blood through them. This is called a ‘spasm’ and can weaken your blood vessels and make them more likely to burst. Taking cocaine can also lead to a sudden, temporary rise in blood pressure, which increases your risk of a haemorrhagic stroke too.

About our health information

At Bupa we produce a wealth of free health information for you and your family. We believe that trustworthy information is essential in helping you make better decisions about your health and care. That’s why our content is produced to the highest quality standards. Look out for the quality marks on our pages below. You can find out more about these organisations and their standards on The Information Standard and HON Code websites.

Has our health information helped you?

We’d love to know what you think about what you’ve just been reading and looking at – we’ll use it to improve our information. If you’d like to give us some feedback, our short survey on the right will take just a few minutes to complete. And if there's a question you want to ask that hasn't been answered here, please submit it to us. Although we can't respond to specific questions directly, we’ll aim to include the answer to it when we next review this topic.

Legal disclaimer

This information was published by Bupa's Health Content Team and is based on reputable sources of medical evidence. It has been reviewed by appropriate medical or clinical professionals. Photos are only for illustrative purposes and do not reflect every presentation of a condition.

The information contained on this page and in any third party websites referred to on this page is not intended nor implied to be a substitute for professional medical advice nor is it intended to be for medical diagnosis or treatment. Third party websites are not owned or controlled by Bupa and any individual may be able to access and post messages on them. Bupa is not responsible for the content or availability of these third party websites. We do not accept advertising on this page.

For more details on how we produce our content and its sources, visit the 'About our health information' section.